Link: https://pubmed.ncbi.nlm.nih.gov/31704054-longitudinal-analysis-of-ventilation-perfusion-mismatch-in-congenital-diaphragmatic-hernia-survivors/

J Pediatr
2019 Nov 5[Online ahead of print]
Longitudinal Analysis of Ventilation Perfusion Mismatch in Congenital Diaphragmatic Hernia Survivors
Duy T Dao 1, Ali Kamran 2, Jay M Wilson 3, Catherine A Sheils 4, Virginia S Kharasch 5, Mary P Mullen 6, Samuel E Rice-Townsend 2, Jill M Zalieckas 2, Donna Morash 2, Mollie Studley 2, Steven J Staffa 7, David Zurakowski 7, Ronald E Becker 8, Charles J Smithers 9, Terry L Buchmiller 10
Affiliations expand
PMID: 31704054 DOI: 10.1016/j.jpeds.2019.09.053
Abstract
Objective: To determine the natural history of pulmonary function for survivors of congenital diaphragmatic hernia (CDH).

Study design: This was a retrospective cohort study of survivors of CDH born during 1991-2016 and followed at our institution. A generalized linear model was fitted to assess the longitudinal trends of ventilation (V), perfusion (Q), and V/Q mismatch. The association between V/Q ratio and body mass index percentile as well as functional status was also assessed with a generalized linear model.

Results: During the study period, 212 patients had at least one V/Q study. The average ipsilateral V/Q of the cohort increased over time (P < .01), an effect driven by progressive reduction in relative perfusion (P = .012). A higher V/Q ratio was correlated with lower body mass index percentile (P < .001) and higher probability of poor functional status (New York Heart Association class III or IV) (P = .045).

Conclusions: In this cohort of survivors of CDH with more severe disease characteristics, V/Q mismatch worsens over time, primarily because of progressive perfusion deficit of the ipsilateral side. V/Q scans may be useful in identifying patients with CDH who are at risk for poor growth and functional status.

Keywords: congenital diaphragmatic hernia; generalized estimating equations; generalized linear model; perfusion; ventilation.

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